EXIT Education Fest 2019 -- $250 Scholarship Registration To enter the scholarship drawing and register for the event, please answer all the questions below. Be sure to hit submit when you are finished. OK Question Title * 1. First Name OK Question Title * 2. Last Name OK Question Title * 3. Please provide your contact information. Mailing Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Email Address * Phone Number * OK Question Title * 4. What is your date of birth? Example: 8/13/1975 OK Question Title * 5. Which programs are you considering? Please select all that apply. Allied Health (Certified Nursing Assistant, Nursing, Medication Aide, Phlebotomy, Pharmacy Tech, Medical Coding & Billing, and Sports Medicine) Autobody (Collision Repair & Refinishing) Automotive Basic Law Enforcement Training (BLET) Cosmetology Computer Software Training (Computer Skills, Smartphone, Tablets, Google Docs, Photoshop, Microsoft programs) Computer Programming (C++ and C#) Construction Digital Media/Graphic Design English as Second Language (English Language Acquisition) Emergency Medical (EMT-B and Paramedic) Electrical Systems (Residential/Commercial Wiring and National Electrical Code) Electronics (AC and DC Circuits/Controls) Engineering Design (Drafting) Fire, Rescue and Hazardous Materials Training High School Equivalency and Adult High School Diploma Horticulture Human Resources Development (Career Development Classes) HVAC (Air Conditioning, Heating and Refrigeration) Industrial Systems Machining Mechatronics (Mechanical, Electronics and Robotics) Motorcycle Safety Music Classes (String Band, Mandolin, Claw-Hammer Banjo, Fiddle and Guitar) Personal Enrichment (Pottery, Painting, Photography, Dancing, Quilting, Sewing, Yoga and other Hobbies) Project Management Taxidermy Truck Driver Training (NC CDL Training) Trucking Operations Management (Logistics) Upholstery Welding Woodworking Violin Building (Luthier) Viticulture and Enology (Grape Growing and Wine Making) Undecided OK Question Title * 6. How did you hear about Education Fest? Please check all that apply. Word of mouth (family member, friend or teacher told me) Television advertisement Social Media (Facebook, Instagram, YouTube, Twitter, LinkedIn) Advertisement on my phone or computer Email Flyer or brochure Newspaper Radio OK SUBMIT RESPONSE